Original Paper
Eur Neurol 2015;73:164–170
DOI: 10.1159/000370240
Timing of Neurological Improvement
after Acute Ischemic Stroke and
Functional Outcome
Young-Mok Song Geun Ho Lee Jae Il Kim 
Department of Neurology, Dankook University Hospital, Cheonan, South Korea
Key Words
Stroke · Neurological improvement · Outcome
Abstract
Background: The time of neurological improvement (TNI)
after acute ischemic stroke may have a predictive value.
Methods: We evaluated 410 consecutive patients who were
admitted within 12 hours of stroke onset. The National Insti-
tutes of Health Stroke Scale (NIHSS) was measured on ad-
mission and at 1, 3, 7, and 14 days. Neurological improve-
ment was defined as an improvement in the NIHSS score by
≥2 points (NI2) or ≥4 points (NI4) or an NIHSS score of 0.
Patients with a Modified Rankin scale (mRS) score of ≤2 were
considered to have a good outcome. Results: Patients with
earlier TNIs had a lower 3-month mRS score and a higher
probability for a good outcome. In the binary and ordinal
regression analyses, age, NIHSS score, atrial fibrillation and
TNI were independently associated with a good outcome.
Receiver operating characteristic curve analyses demon-
strated that TNI2 had higher sensitivity and lower specificity
than TNI4. The best threshold for predicting outcome was
day 3 for TNI2 and day 14 for TNI4. Conclusions: These re-
sults suggest that TNI is independently associated with
functional outcome at 90 days. TNI2 may be more useful
than TNI4 for early prediction of stroke outcome.
© 2015 S. Karger AG, Basel
© 2015 S. Karger AG, Basel
0014–3022/15/0734–0164$39.50/0
E-Mail karger@karger.com
www.karger.com/ene
Received: September 30, 2014
Accepted: November 30, 2014
Published online: January 13, 2015
Introduction
The clinical course and prognosis of stroke patients are
highly variable. Therefore, the prediction of outcome after
acute stroke has been an important research issue. The
stroke outcome is influenced by multiple factors. Some fac-
tors, such as age and the initial National Institutes of Health
Stroke Scale (NIHSS) score [1], have been recognized as
prognostic factors [2–7]. However, the current predictors
are not sufficient for precise prediction of prognosis, and
identification of more predictive factors is necessary.
The clinical course during the acute phase of stroke may
have a predictive value. Indeed, it has been reported that
patients who improved within the first 48 hours of stroke
onset had a better prognosis [8, 9], suggesting that early
neurological improvement is predictive of a good progno-
sis. However, a detailed relationship between the time of
neurological improvement (TNI) and functional outcome
has not been elucidated. The purpose of this study was to
investigate the relationship between the TNI after acute
ischemic stroke and functional outcome at 3 months.
Methods
We prospectively studied consecutive patients with acute isch-
emic stroke who were admitted to the Dankook University hospi-
tal between January 2010 and December 2013. A total of 579 pa-
130.241.16.16 - 11/15/2017 8:33:38 PM
Young-Mok Song, MD
Department of Neurology, Dankook University Hospital
119, Dandae-ro, Dongnam-gu
Göteborgs Universitet
Cheonan, Chungnam, 330–714 (South Korea)
Downloaded by:
E-Mail ymsong @ medimail.co.kr
tients eligible for the study had focal neurologic deficits with rel-
evant lesions on diffusion-weighted imaging and were examined
within 12 h of symptom onset. Among them, we excluded the pa-
tients who had preexisting neurological deficits (65 patients), those
who received thrombolytic therapy (57 patients), and those who
did not undergo complete workups (22 patients) or were lost to
follow-up (25 patients). Thus, 410 patients with acute ischemic
stroke were finally selected for the analyses.
Demographic data and stroke risk factors were recorded in
the registry. Data on risk factors were collected and defined as
follows: hypertension was defined as repeated detection of blood
pressure >140/90 mm Hg before stroke or use of antihypertensive
medication; diabetes mellitus was defined as repeated detection
of fasting blood glucose level >140 mg/dl before stroke or use of
antidiabetic medication; hypercholesterolemia was defined as re-
peated detection of total cholesterol >220 mg/dl or use of lipid-
lowering medication; smoking was defined as current smoking
at the time of stroke; and potential sources of cardioembolism
were defined as atrial fibrillation, myocardial infarction within
6 weeks, congestive heart failure, mitral stenosis, and prosthetic
valve.
All of the patients underwent laboratory workups that included
brain MRI, MR angiography, transthoracic echocardiography, 12-
lead ECG, and standard blood tests. Conventional angiography,
transcranial Doppler, transesophageal echocardiography, and
Holter monitoring were performed in selected patients as re-
quired. An etiologic subtype of ischemic stroke was classified into
large artery disease, cardioembolism, small vessel disease, and un-
determined cause according to the Trial of Org 10172 in Acute
Stroke Treatment (TOAST) criteria [10].
The severity of the neurological deficits was assessed using the
NIHSS. The NIHSS score was serially measured on admission and
at 1, 3, 7, and 14 days after stroke onset. Neurological improvement
(NI4) was defined as a decrease in the NIHSS score by ≥4 points
from the baseline NIHSS score or a NIHSS score of 0. We also con-
sidered minor neurological improvement (NI2) as a NIHSS score
change by ≥2 points or a NIHSS score of 0. The time of neurolog-
ical improvement (TNI4) or the time of minor neurological im-
provement (TNI2) was classified into day 1, 3, 7, 14, and no im-
provement. Modified Rankin Scale (mRS) was used to assess the
functional outcome at 3 months [11]. For the purpose of the anal-
ysis, patients who had an mRS score of 0–2 were considered to have
a good outcome. If patients were discharged from the hospital dur-
ing the study period, they were evaluated at the outpatient clinic
on the scheduled day. If patients could not visit the hospital at
3  months because of severe disability or other causes, the mRS
score was measured by a telephone interview.
Statistical Analysis
A comparison of the baseline characteristics and outcome pro-
files among patients with different time of neurological improve-
ment was performed by the ANOVA test for continuous variables
and by the χ2 test for dichotomized variables. Binary logistic and
ordinal regression analyses were used to assess the effects of TNIs
on clinical outcome adjusted for variables showing a p < 0.2 in
univariate analysis. In binary logistic models, mRS was dichoto-
mized (mRS ≤2 vs. mRS >2) and a backward stepwise strategy was
used to select the variables remaining in the final model. We con-
structed ordinal regression models to verify that the results were
consistent across the levels of the mRS adjusted for factors and
Timing of Improvement and Stroke
Outcome
covariates related to dichotomized mRS in the binary logistic re-
gression analysis. Receiver operating characteristic (ROC) curve
analysis was conducted to evaluate the usefulness of the TNI2 and
TNI4 for predicting a good outcome. We assessed the discrimina-
tion by calculating the area under the ROC curve of sensitivity
versus 1 minus the specificity. The sensitivity, specificity, and pos-
itive and negative predictive values of the TNI2 and TNI4 were
calculated to validate the TNIs in predicting a good outcome at
3 months.
Statistical significance was established at p < 0.05. Statistical
analyses were performed using SPSS (version 18.0, Chicago, Ill.,
USA) and Medcalc (version 13.3).
Results
There were 243 men and 167 women, and the mean age
was 65.6 ± 11.9 years (range, 26–93 years). The TNI2 was
day 1 in 95 (23%) patients, day 3 in 131 (32%) patients,
day 7 in 92 (22%) patients, day 14 in 36 (9%) patients, and
no improvement within 14 days was observed in 56 (14%)
patients. The TNI4 was day 1 in 28 (7%) patients, day 3 in
54 (13%) patients, day 7 in 83 (20%) patients, day 14 in 84
(21%) patients, and no improvement in 161 (39%) pa-
tients. The clinical characteristics of patients who showed
different TNI2 and TNI4 are listed in tables 1 and 2. The
mean time from symptom onset to study entry was 4.6 ±
3.3 h. The mean initial NIHSS score was 6.9 ± 5.1 (range,
1–29; median, 5; interquartile range, 4–9). There was no
difference in terms of age, sex, vascular risk factors, and
stroke subtype between patients with different TNI2 or
TNI4. The initial neurological deficits measured by the
NIHSS were the most severe in patients who showed no
improvement within 14 days of stroke onset (10.7 ± 7.8
for TNI2, p < 0.01 and 7.6 ± 5.9 for TNI4, p < 0.01).
Patients who showed earlier improvement had a high-
er probability for a good outcome. Most (86% for TNI2
and 92% for TNI4) of the patients who improved within
one day had a good outcome and the rate of good out-
come decreased as the neurological improvement oc-
curred later. Of the patients who did not show improve-
ment within 14 days, 30% (TNI2) and 52% (TNI4) of
them achieved a good outcome.
Univariate logistic regression analysis revealed that
the outcome was associated with age, NIHSS score, atrial
fibrillation, stroke subtype, TNI2, and TNI4 (table  3).
Among these variables, age, NIHSS score, atrial fibrilla-
tion, and TNI2 or TNI4 were selected in the final model
(table 4). TNI2 (OR, 2.23; 95% CI, 1.73–2.87; p < 0.01)
and TNI4 (OR, 2.30; 95% CI, 1.71–3.10; p < 0.01) were
independently associated with an outcome at 90 days in
the adjusted binary regression model. Ordinal regression
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Eur Neurol 2015;73:164–170 165
DOI: 10.1159/000370240
Göteborgs Universitet
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Table 1. Clinical characteristics of patients with different time of minor neurological improvement (TNI2)

Day 1 Day 3 Day 7 Day 14 No NI p

Patients, n 95 131 92 36 56
Age, years (mean ± SD) 66.1±12.4 64.5±11.4 64.6±11.5 63.8±12.8 69.9±12.0 0.39
Males, n (%) 61 (64) 75 (57) 58 (63) 21 (58) 28 (50) 0.44
Time from onset to entry, h (mean ± SD) 3.9±3.2 5.3±3.6 6.0±3.8 3.9±2.2 3.5±2.2 <0.01
Initial NIHSS score (mean ± SD) 6.5±4.2 6.3±4.2 6.0±3.6 6.4±4.6 10.7±7.8 <0.01
Median (interquartile range) 5 (3–9) 5 (3.25–8) 5 (4–7.5) 5 (3.75–7.25) 9.5 (4.25–17.75)
Risk factors, n (%)
Hypertension 61 (64) 80 (61) 61 (66) 21 (58) 39 (70) 0.74
Diabetes mellitus 19 (20) 37 (28) 26 (28) 10 (28) 19 (34) 0.42
Hyperlipidemia 24 (25) 23 (18) 25 (27) 11 (31) 8 (14) 0.14
Smoking 24 (25) 43 (33) 34 (37) 13 (36) 18 (32) 0.51
Atrial fibrillation 26 (27) 18 (14) 17 (19) 7 (19) 17 (30) 0.04
Previous stroke 18 (19) 22 (17) 10 (11) 9 (25) 9 (16) 0.35
Stroke subtypes, n (%) 0.06
Large artery disease 27 (28) 41 (31) 24 (26) 10 (28) 17 (30)
Cardioembolism 23 (24) 19 (15) 15 (16) 6 (17) 20 (36)
Small vessel disease 31 (33) 50 (38) 39 (42) 16 (44) 9 (16)
Undetermined 14 (15) 21 (16) 14 (15) 4 (11) 10 (18)
mRS at 3 months (mean ± SD) 1.3±1.1 1.6±1.3 1.8±1.3 2.3±1.4 3.8±1.8 <0.01
Good outcome*, n (%) 82 (86) 102 (78) 67 (73) 21 (59) 17 (30) <0.01

* Modified Rankin Scale score at 3 months after stroke ≤2.

Table 2. Clinical characteristics of patients with different time of neurological improvement (TNI4)

Day 1 Day 3 Day 7 Day 14 No NI p

Patients, n 28 54 83 84 161
Age, years (mean ± SD) 63.1±14.7 65.5±10.3 66.0±11.7 65.5±11.0 65.8±12.6 0.85
Males, n (%) 21 (75) 31 (57) 49 (59) 47 (56) 95 (59) 0.50
Time from onset to entry, h (mean ± SD) 2.7±2.9 3.8±3.5 4.7±3.0 5.9±3.3 4.5±3.4 0.02
Initial NIHSS score (mean ± SD) 6.7±4.4 6.6±4.3 6.0±4.5 6.5±4.3 7.6±5.9 0.15
Median (interquartile range) 6 (2.75–9.25) 5 (4–10) 5 (3–8) 5 (4–8) 6 (4–10)
Risk factors, n (%)
Hypertension 16 (57) 37 (69) 51 (61) 52 (62) 109 (68) 0.67
Diabetes mellitus 5 (18) 11 (20) 27 (33) 25 (30) 43 (27) 0.41
Hyperlipidemia 5 (18) 16 (30) 23 (28) 20 (24) 27 (17) 0.17
Smoking 9 (32) 19 (35) 35 (42) 30 (36) 51 (32) 0.60
Atrial fibrillation 10 (36) 9 (17) 16 (19) 13 (16) 37 (23) 0.17
Previous stroke 4 (14) 7 (13) 17 (21) 13 (16) 27 (17) 0.81
Stroke subtypes, n (%) 0.43
Large artery disease 7 (25) 15 (28) 27 (33) 27 (32) 43 (27)
Cardioembolism 10 (36) 9 (17) 14 (17) 12 (14) 38 (24)
Small vessel disease 8 (29) 19 (35) 26 (31) 31 (37) 61 (38)
Undetermined 3 (11) 11 (20) 16 (19) 14 (17) 19 (12)
mRS at 3 months (mean ± SD) 0.7±1.1 1.4±1.2 1.6±1.3 1.7±1.5 2.8±1.8 <0.01
Good outcome*, n (%) 26 (92) 44 (82) 63 (76) 65 (74) 84 (52) <0.01

* Modified Rankin Scale score at 3 months after stroke ≤2.

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166 Eur Neurol 2015;73:164–170 Song/Lee/Kim

DOI: 10.1159/000370240
Göteborgs Universitet
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Table 3. Univariate binary logistic regression analysis for a good 65%; positive predictive value, 81%; negative predictive
outcome value, 43%) and day 14 for TNI4 (sensitivity, 68%; speci-
ficity, 61%; positive predictive value, 79%; negative pre-
Good outcome (mRS ≤2)
dictive value, 48%).
p OR (95% CI)

Age <0.01 0.96 (0.94–0.98)

Sex, male 0.10 1.43 (0.93–2.19) Discussion
Time from onset to entry 0.12 1.09 (0.98–1.21)
Initial NIHSS score <0.01 0.72 (0.67–0.78) The effect of early neurological improvement on out-
Risk factors come has been mostly studied in clinical trials with
Hypertension 0.47 1.18 (0.76–1.82)
Diabetes mellitus 0.28 0.78 (0.49–1.24) thrombolytic treatment [12–15]. They focused on the im-
Hypercholesterolemia 0.69 1.11 (0.66–1.85) mediate clinical response with recanalization after throm-
Smoking 0.50 1.18 (0.74–1.85) bolysis. Although a majority of stroke patients do not re-
Atrial fibrillation <0.01 0.35 (0.21–0.57) ceive thrombolytic therapy, only a few studies analyzed
Previous stroke 0.68 0.89 (0.51–1.55) the effect of early spontaneous improvement on outcome.
Stroke subtypes
Large artery disease 0.08 0.55 (0.29–1.07) Our data suggest that earlier improvement is associated
Cardioembolism 0.04 0.47 (0.24–0.95) with a better 3-month mRS score and a higher likelihood
Small vessel disease <0.01 2.82 (1.35–5.90) of functional independence in patients who are not treat-
Undetermined 1 ed with thrombolytic agents. A previous study by Toni
TNI2 et  al. analyzed the TNI limited to 48 h [9]. They ob-
Day 1 <0.01 14.23 (6.0–33.88)
Day 3 <0.01 8.41 (4.29–16.50) served that improving patients (an improvement of the
Day 7 <0.01 6.35 (3.10–13.01) Canadian Neurological Scale score ≥1 point) within the
Day 14 0.07 3.33 (1.39–8.02) first 48 h after stroke had a lower fatality and disability,
No improvement 1 and improvement within 48 h was independently associ-
TNI4
ated with a good outcome. The present study provided
Day 1 0.01 11.07 (2.52–48.52)
Day 3 <0.01 4.20 (1.91–9.26) more detailed information on the relationship between
Day 7 0.01 2.88 (1.51–5.51) the TNIs up to 14 days and the stroke outcome. More-
Day 14 0.03 2.26 (1.37–4.80) over, the association between the TNI and outcome was
No improvement 1 further verified in ordinal regression analysis, which
OR = Odds ratio; CI = confidence interval.
might complement the limitation of dichotomized out-
come analysis. The concept that patients with earlier im-
provement had a better prognosis may be generally ap-
plied to the acute period of stroke.
We compared the predictive value of TNI2 and TNI4
analysis demonstrated a significant shift toward a better in the ROC analysis. Both TNIs showed a similar area un-
mRS scale in patients with earlier TNI2 (OR, 1.97; 95% der the ROC curve (0.701 vs. 0.671, p = 0.54), but TNI2
CI, 1.70–2.31; p < 0.01) or earlier TNI4 (OR, 2.10; 95% CI, showed a higher sensitivity and lower specificity than
1.79–2.47; p < 0.01). When the TNIs were categorized TNI4. The best cut-off time for predicting outcome was
into each period, the TNIs of earlier periods showed a day 3 for TNI2 (sensitivity, 63%; specificity, 65%) and day
higher odds ratio for a good outcome in binary and ordi- 14 for TNI4 (sensitivity, 65%; specificity, 61%). Thus,
nal analyses (table 4). TNI2 is better than TNI4 for early prediction of outcome.
The ROC curve for TNI2 and TNI4 that predict a good In addition, using TNI2 yielded a higher number of sub-
outcome is shown in figure 1. The area under the ROC jects for analysis. About 39% of patients were classified as
curve did not differ significantly between TNI2 and TNI4 those with no improvement using the TNI4 criteria,
(0.701 vs. 0.671, p = 0.54). Overall, using TNI2 for predic- whereas only 14% of patients were classified as those with
tion of 90-day outcome showed higher sensitivity and no improvement according to the TNI2 criteria.
lower specificity than using TNI4, but the positive and Most studies on thrombolytic treatment have adopted
negative predictive values were similar between TNI2 and the definition of neurological improvement requiring a
TNI4 (table 5). The best threshold for predicting a good change of ≥4 points or ≥8 points in the NIHSS score [12–
outcome was day 3 for TNI2 (sensitivity, 63%; specificity, 14]. Patients with a low baseline NIHSS score may be less
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Timing of Improvement and Stroke Eur Neurol 2015;73:164–170 167

Outcome DOI: 10.1159/000370240
Göteborgs Universitet
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Table 4. Multivariate binary logistic and ordinal regression models for outcome including the TNI2 or TNI4

Binary logistic analysis Ordinal analysis

(mRS ≤2 vs. mRS >2) (mRS 0–6)
p OR (95% CI) p OR (95% CI)

Age 0.04 0.97 (0.95–0.99) 0.01 0.97 (0.96–0.99)

Atrial fibrillation 0.01 0.27 (0.13–0.58) <0.01 0.36 (0.23–0.58)
Initial NIHSS <0.01 0.69 (0.63–0.75) <0.01 0.75 (0.72–0.79)
TNI2
Day 1 <0.01 31.08 (9.21–104.9) <0.01 22.02 (10.78–44.96)
Day 3 <0.01 8.66 (3.44–21.84) <0.01 8.58 (4.63–15.87)
Day 7 0.01 5.00 (1.93–12.81) <0.01 6.65 (3.46–12.78)
Day 14 0.26 1.88 (0.62–5.72) 0.02 3.45 (1.55–7.67)
No improvement 1 1
Age 0.06 0.98 (0.95–1.00) 0.02 0.97 (0.96–0.99)
Atrial fibrillation <0.01 0.30 (0.13–0.67) <0.01 0.32 (0.19–0.55)
Initial NIHSS <0.01 0.69 (0.63–0.75) <0.01 0.74 (0.70–0.77)
TNI4
Day 1 <0.01 28.98 (4.90–171.3) <0.01 37.96 (15.14–95.15)
Day 3 <0.01 12.12 (3.91–37.59) <0.01 7.12 (3.83–13.24)
Day 7 <0.01 4.95 (2.03–12.12) <0.01 4.31 (2.49–7.46)
Day 14 0.03 3.47 (1.54–7.84) <0.01 3.98 (2.32–6.84)
No improvement 1 1

OR = Odds ratio; CI = confidence interval.

likely to meet these criteria of neurological improvement

ROC curve
unless they reach a NIHSS score of 0. We addressed this
1.0 concern by analyzing the minor neurological improve-
ment with a change of ≥2 points on the NIHSS score
(TNI2). In contrast to clinical trials with thrombolytic
0.8 treatment in which moderate severity of stroke patients
were mainly enrolled, this study included all severity of
stroke patients covering patients with a minor stroke. In-
0.6 deed, the baseline NIHSS score (median, 5) of this study
Sensitivity

population was lower than that of clinical trials (median,

9, 14 or 17) [15–18]. Therefore, the criteria of TNI2 may
0.4 be more sensitive than that of TNI4 for prediction of out-
come in this population.
In previous reports, several clinical characteristics
0.2
including NIHSS score, age, and atrial fibrillation have
shown to influence the functional outcome [2–7, 19]. In
TNI2 our regression analysis, these variables were also identi-
TNI4
fied as independent predictors, corroborating the re-
0
0 0.2 0.4 0.6 0.8 1.0 sults of previous studies. With regard to stroke subtype,
1 – specificity lacunar stroke or dysarhria-clumsy hand syndrome has
been suggested as a significant predictor of spontaneous
good outcome [5, 20]. In our study, lacunar infarction
Fig. 1. ROC curve comparing TNI2 and TNI4 for predicting a good was associated with a good outcome, but after multi-
outcome. variate adjustment, the association was not significant.
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168 Eur Neurol 2015;73:164–170 Song/Lee/Kim

DOI: 10.1159/000370240
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Table 5. The sensitivity, specificity, and positive and negative predictive values with 95% confidence intervals of TNI2 and TNI4 for
predicting a good outcome (mRS ≤2)

Sensitivity Specificity + Predictive value – Predictive value

Criteria TNI2 TNI4 TNI2 TNI4 TNI2 TNI4 TNI2 TNI4

Day 1 21.3 (16.7–26.5) 9.92 (6.5–14.4) 91.9 (85.7–96.1) 98.3 (93.9–99.8) 85.9 (75.6–93.0) 92.3 (74.9–99.1) 33.6 (28.6–38.9) 34.3 (29.2–39.7)
Day 3 62.9 (57.1–68.5) 26.9 (21.4–32.9) 65.3 (56.3–73.6) 90.5 (83.7–95.2) 80.7 (74.9–85.7) 85.5 (75.6–92.5) 43.3 (36.1–50.7) 37.2 (31.6–43.2)
Day 7 86.7 (82.2–90.4) 47.5 (41.1–54.0) 45.2 (36.2–54.3) 76.7 (68.0–84.1) 78.5 (73.5–82.9) 81.0 (73.6–87.1) 59.6 (49.0–69.6) 41.2 (34.6–48.1)
Day 14 93.7 (90.2–96.2) 68.2 (61.9–74.0) 33.9 (25.6–42.9) 61.2 (51.7–70.1) 76.6 (71.8–80.9) 78.6 (72.4–83.9) 70.0 (56.8–81.2) 48.0 (39.7–56.3)

The association may depend on the NIHSS score or oth-
er factors.
This study has some limitations. As we recruited acute
ischemic stroke patients within 12 h after onset, the pa-
tients who had already improved prior to hospital arrival
may have not been considered having neurological im-
provement. The frequency of patients with a certain pe-
riod of TNI, especially a TNI of day 1, may vary depend-
ing on the time elapsed from stroke onset to admission.
Nevertheless, the data are clinically valuable because
some delay from stroke onset to hospital arrival is also
present in clinical setting.
We did not exclude patients who improved to no def-
icit at day 1 (transient ischemic attack, TIA) if they had
neurological deficits on admission and had a relevant le-
sion on DWI. According to the tissue-based definition of
TIA, only traditional TIA without evidence of acute in-
farction on brain imaging is classified as TIA [21]. Thus,
we classified these patients as stroke patients. Although
this classification is controversial, such patients were
small in number (8 patients) and may have not affected
the overall results.
We excluded patients treated with thrombolysis, be-
cause our study focused on the natural course of stroke,
and statistical analyses and interpretation were compli-
cated as the baseline characteristics of thrombolysis-
treated patients were specific and distinct from those of
patients who were not treated with thrombolysis. The
clinical implication may also differ between spontaneous
improvement and improvement associated with throm-
bolytic treatment. Further studies, however, including
thrombolysis-treated patients and adjusting these factors
will provide more valuable information.
In conclusion, our data suggest that TNI after acute
ischemic stroke is independently associated with func-
tional outcome at 90 days. In addition to initial NIHSS
score and age, the TNI can be a valid predictor of the
stroke outcome. TNI2 may be more useful than TNI4 for
early prediction of outcome in patients who did not re-
ceive thrombolytic therapy.
Disclosure Statement
None.
Funding
The present research was conducted by the research fund of
Dankook University in 2013.

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